Obtaining health care abroad

For those travelling abroad, it’s a good idea to be informed about accessing medical care in the destination country or countries. There may be some cases where health care is needed abroad. For example, a person may fall ill abroad or, in cases of severe travel disruption, it is possible that an individual may run out of their HIV medication. Dealing with this situation varies for different countries, but providing as much documentation as possible will help to limit the costs of obtaining medicines and the time taken to get them.

People with HIV from the UK who are stranded overseas can approach local HIV clinics or support organisations for help. You can search for organisations and clinics by country on the aidsmap website: www.aidsmap.com/e-atlas.

It is likely that any treatment needed abroad will have to be paid for, but it may be possible to access some care at a reduced cost, for free, or to obtain a refund.

Whatever their destination, people with HIV should make sure that they have appropriate travel insurance, even if some health care is offered by that country for free or at a reduced cost.

Those carrying a European Health Insurance Card (EHIC) can use this throughout the European Economic Area to obtain whatever is freely available through the local health system. What is offered varies in each country but receipts for any healthcare costs should always be kept in case of possible refunds. The European Economic Area includes the following countries: Austria, Belgium, Bulgaria, Cyprus, Czech Republic, Denmark, Estonia, Finland, France, Germany, Gibraltar, Greece, Hungary, Iceland, Ireland, Italy, Latvia, Liechtenstein, Lithuania, Luxembourg, Malta, Netherlands, Norway, Poland, Portugal, Romania, Slovakia, Slovenia, Spain (including the Canaries and the Balearics, which are provinces of Spain), and Sweden.

Everyone who is resident in the UK should have the EHIC and carry it with them when travelling abroad. Applying for the card is free and it's valid for up to five years. The EHIC can be obtained at www.ehic.org.uk, or by telephoning 0845 606 2030. The card should arrive within 10 days of application.

Presenting the EHIC entitles the holder to treatment that may become necessary during a trip in the European Economic Area, but doesn't allow people to go abroad specifically to receive medical care. Maternity care, renal dialysis and managing the symptoms of pre-existing or chronic conditions that arise while abroad in the European Economic Area are all covered by the EHIC.

Many countries will expect some payment towards treatment, even with an EHIC. Those paying for treatment may be able to seek reimbursement for these costs. The refund may have to be obtained whilst still in the country where the treatment was received. Some agreements allow for refunds to be obtained once back in the UK, but this can be a lengthy process.

Specific guidance for British citizens on how to access health care or claim refunds during a visit to a country in the European Economic Area can be found on the NHS website: www.nhs.uk/NHSEngland/Healthcareabroad/countryguide/Pages/EEAcountries.aspx

In some countries where the European Health Insurance Card (EHIC) is not valid, there may still be some urgent healthcare services available at a reduced cost, or for free. The following countries have a reciprocal healthcare agreement with the UK: Anguilla, Armenia, Australia, Azerbaijan, Barbados, Belarus, Bosnia and Herzegovina, British Virgin Islands, Channel Islands, Croatia, Falkland Islands, Georgia, Gibraltar, Isle of Man, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Montserrat, New Zealand, Russia, St Helena, Serbia and Montenegro, Tajikistan, Turkmenistan, Turks and Caicos Islands, Ukraine, and Uzbekistan.

Each country has different rules. Costs associated with health care should be researched before travel. A full list can be found on the NHS website: www.nhs.uk/NHSEngland/Healthcareabroad/countryguide/NonEEAcountries/Pages/Non-EEAcountries.aspx

Those needing urgent medical care should be treated as if they were a resident, but the agreements do not cover the cost of any flights to return home or the monitoring of pre-existing conditions. Generally, these agreements cover UK nationals living in the UK. Those who are not nationals, but who normally live in the UK, may also be covered. In either case, identification documentation such as a passport or driver’s license is needed.

The range of medical services in countries with reciprocal agreements outside the European Economic Area is usually more restricted than those provided with an EHIC card.

The agreements may not apply to those planning to live or work in one of the countries with reciprocal agreements.

In countries other than those mentioned above, any medical costs will need to be paid for. Cost for health care can be extremely high. With appropriate travel insurance these costs can usually be claimed back, but there are exclusions to consider (see Travel insurance). It is therefore vital for people with HIV to obtain an appropriate level of comprehensive travel insurance before travelling.

Those receiving medical care abroad should always keep receipts to enable costs to be claimed on travel insurance.

General advice for British citizens on health care abroad can be found on the NHS website: www.nhs.uk/NHSEngland/Healthcareabroad/Pages/Healthcareabroad.aspx

The Foreign and Commonwealth Office (FCO) website has comprehensive travel advice by country, including information about UK embassies and consular offices: www.fco.gov.uk

European law supports the right of people living in Europe to seek health care in other European Economic Area countries – and have their costs reimbursed by the healthcare system in the country they come from.

In terms of NHS patients, they have the right to seek health care in another European country as long as the treatment is normally available on the NHS (i.e. it doesn’t cover treatments that the NHS considers to be insufficiently effective or too expensive to provide). The NHS will cover the cost, up to the amount it would have cost the NHS to provide. If the overseas treatment is more expensive, the patient pays the difference.

Patients may need to get prior authorisation for treatment, for example if it will involve a hospital stay.

The Department of Health issued guidance on this in 2010.¹ Some details of the guidance may change when UK legislation is introduced to implement the 2011 European Union directive on patients’ rights in cross-border health care.²

An NHS prescription is not valid overseas. Anyone needing prescription drugs while travelling may need to obtain an appointment with a doctor in that country in order to get a prescription, but this will not be the case in all countries. In some countries it is possible to buy prescription drugs without a prescription from a pharmacy. However, caution should be taken as not all countries thoroughly regulate the sale and production of medicines.

If HIV treatment is required abroad, a letter by email or fax should be obtained from the HIV clinic where treatment is prescribed at home. This should detail what treatment is normally prescribed and the correct dosages.